Possible causes are vitamin A deficiency, Acute Phase Reaction, or Protein
Calorie Malnutrition. We routinely evaluate low serum retinol concentrations
by doing RBP and CRP. Zinc deficiency could also result in decreased RBP
synthesis. It has been suggested that Retinyl Esters give a better
indication of Vitamin A excess. These are not generally quantified in
routine HPLC methods. Other published methods of evaluating vitamin A
status include 'Conjunctival Impression Cytology' and the 'Relative Dose
Response Test'.
Best wishes,
Nuala
Dr Nuala McCarroll
Principal Biochemist
Department of Clinical Biochemistry
St James's Hospital
Dublin 8
Ireland
-----Original Message-----
From: Fisher, Roy - RCHT [mailto:[log in to unmask]]
Sent: 28 April 2003 10:41
To: [log in to unmask]
Subject: Low serum Vitamin A level in CF patient
One of our paediatricians has a four year old girl with cystic fibrosis who
has been on Vitamin A and Vitamin E supplements for the past 3 years. She
has had persistently low serum Vitamin A levels, the most recent in January
this year being 0.9 umol/L (Ref: 1.1 - 3.5). The serum vitamin E and zinc
levels are within the reference range. The total carotenes last year were
0.6 umol/L ( Ref: 0.6 - 2.1).
She is currently taking 25 000 units of Vitamin A daily and there is concern
about potential hepatoxicity with such a high dose, although the LFTs remain
normal. Is there any merit in measuring retinol binding protein or could we
be dealing with a selective malabsorption problem? Any thoughts on how to
further investigate would be gratefully welcome.
Many thanks,
Roy
Dr R A Fisher
Royal Cornwall Hospital,
Truro,
Cornwall,
TR1 3LJ
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